capable family pilot - adapting capable for older adults with mild cognitive impairment (mci)/early stage dementia and their care partners

Conditions: Dementia, Mild; Mild Cognitive Impairment; Disability Physical; Impairment, Cognitive; Caregiver Burden; Quality of Life; Depression

Summary: the purpose of this study is to test the adapted protocol, capable family which builds upon the evidenced based capable program to address older adults with co-occurring physical disability and mild cognitive impairment or early stage dementia and the older adults' caregivers. it will consist of two phases - an open label pilot and waitlist control trial.

capable (na_00031539) is an evidence-based program that reduces physical disability, but was designed for people who are cognitively intact. the investigators seek to adapt capable to meet the needs of older adults with physical disability and mild cognitive impairment and early stage dementia. the investigators also seek to meet the needs of family members who serve as informal caregivers in relation to the physical function of those with cognitive impairment. the purpose of this pilot study is to test a new protocol for a new program, capable family, to address older adults with co-occurring physical disability and dementia and the older adults' caregivers. capable is a multicomponent goal-directed program that reduces physical disability by working with the person and environment, but was designed for people who are cognitively intact. based on the centers for medicare and medicaid (cms) request, the investigators' team briefly included people with mild dementia in the regular capable protocol. looking back on that preliminary data, the investigators identified a subset of 12 older adults with mild dementia with mini-mental state examination (mmse) scores of 23 or below. the investigators found that more than half improved in activities of daily living (adl) and instrumental activities of daily living (iadl) which is promising but much lower than capable the rest of the cohorts which suggests the need to adapt capable for people with dementia. therefore, the investigators have adapted capable for people with mild cognitive impairment or early stage dementia calling it capable family. as in capable (na_00031539), the delivery characteristics of capable family consist of an assessment-driven, individually tailored package of interventions delivered over the course of 4 months by an occupational therapist (ot) (\~6 home visits for ≤ 1hour), a registered nurse (rn) (\~4 home visits for ≤ 1hour) and a handy worker (hw). this research study is a continuation of irb00243117 during which the investigators conducted preliminary activities to design the capable family intervention. this study will include two phases, an open label pilot and a randomized control trial. the investigators will collect feedback during the open label pilot from the study team clinicians, older adult participants and care partners to further refine the intervention that will be tested as part of the randomized control trial.

Eligibility criteria:
inclusion criteria: * have at least 1 adl disability * have mild cognitive impairment or mild dementia (as indicated by clinician diagnosis, subjective cognitive complaints, or blind/telephone montreal cognitive assessment (moca)(score of 16-23) * care partners will be included if they provide \>10 hours of care/week * live in baltimore city/county exclusion criteria: * live in long term care setting

Keywords: activities of daily living instrumental activities of daily living caregiving physical function executive function home intervention mild cognitive impairment early dementia